Glamyo Health: Enhancing Patients' Surgical Experience
By Arunima Rajan
Glamyo Health describes itself as an asset-light healthcare startup operating in the area of elective surgeries. Founded in 2019, Glamyo has already weathered challenging times in the healthcare sector and sees a bright future for its patient-focused approach to services. Arunima Rajan caught up with founders Archit Garg and Dr. Preet Pal Thakur for a chat on their model, their learnings, their role in the healthcare ecosystem, and the road ahead.
Arunima: Archit, could you tell me about yourself and why you do what you do?
Archit: Sure. Before starting Glamyo, I'd spent almost two years on the VC side, where I looked at multiple businesses closely and was involved in businesses at the board level. I did my MBA from Said Business School, part of Oxford University, graduating in 2007. Then, I interviewed with a couple of investment banks in London and joined Deutsche Bank as part of a principal investing team focused on real estate and infra assets in the UK and Europe. I come from a business family, so it was always a goal to start my own business, but I first wanted to learn how to build big businesses. Private equity was the best way to learn how to raise capital and so on.
I then moved to Delhi to join a private equity firm, Milestone Delhi Care which was a USD100 million healthcare education fund. Preet and I were colleagues there. Although they mostly invested in education companies, one of the deals that Preet and I did was with HealthCare Global Enterprises Ltd (HCG).
After our investment, it grew almost 5x in valuation. During these 10-12 years, I wrote five different business plans for ventures, but something or the other was missing until 2019, when Preet was also evaluating starting his venture. That was the key - it was like a marriage made in heaven, with both of us in the same boat at the same time. He had a lot of interesting ideas for healthcare businesses. We discussed doing something in student housing, real estate or fintech, but we kept returning to healthcare.
Arunima: Why surgery in particular?
Archit: We assessed several healthcare segments in terms of ROI and realised that surgery was a wide-open market. Only 10% of Indian hospitals are in the organised space, and 90% of patients have surgeries from unorganised or smaller hospitals. This was a huge market gap. The bigger chains' asset-heavy nature means they reach only 5% of the population, those in a very high-income bracket. We compared surgery with the online healthcare or e-pharmacy space. Ticket sizes there are small, and profitability hard to achieve. With surgeries, the average ticket size is Rs 50,000, and we could scale up at speed because we were not setting up our own hospitals. Our vision became clear: to create an asset-light chain of hospitals and bring quality surgical care to the masses.
Finally, we realised that the patient experience was very broken. So here was a large market with a big problem we were willing to solve.
Arunima: Why do you say the patient experience is broken? Preet, could you also speak about your background, which I understand is relevant here?
Preet: I am a trained doctor, which gives me a base in healthcare. I also have roughly 13+ years of experience after my MBA, and if I had to summarise that experience in one line, I'd say it's about building tomorrow's great companies today. In the last 13 years, I have invested in 13 to 14 companies, 4 of which became the respective largest in their space: India's largest cancer treatment chain, India's largest primary healthcare network and so on. I've been involved with investment banks like JP Morgan, giving me the experience of working in an MNC. Then I got down into the entrepreneurial trenches with companies that I had been involved with funding but which needed more than capital. I worked closely with healthcare firms, solving problems and making decisions. My role was virtually that of a founder. All this gave me an insight into the healthcare ecosystem in India.
One thing became clear to me: there is a real pain point a patient faces when going in for surgery. Surgery is a stressful event, and our healthcare delivery system layers more uncertainty at each level. What will happen during the admission process? How about insurance? What about follow-up? What if the surgery doesn't go as planned? So the question became, how do we remove this uncertainty and deliver quality healthcare to the patient?
Arunima: I had a question about your model: today, I might want to go to a particular hospital because I want my surgery to be conducted by a specific doctor there. What value could you add in that situation?
Preet: That's a great example. You want to be operated by Dr. Preet at X hospital. The hospital charges Rs. 1 lakh, 20 thousand, and it's out of your budget. What's more, like around 95% of the population you don't have insurance. So we tie-up with Dr Preet to operate at what we could call a 4-star hospital. It may be a notch below the marquee names in terms of outer swankiness but has a fully functional ICU, clean, hygienic beds, top staff, and good quality food. So we can get you operated by the same doctor, and at Rs.60 thousand, which is way more affordable.
Archit: We're solving three primary challenges for the patient. The majority of patients have insufficient information, so they think they have to go to the top brands. We provide an online platform that tells you what the best hospitals in your city for each speciality actually are and your options for treatments and procedures. The next problem is access. Typically, when you go to a hospital, you're on your own through the various processes. We assign relationship managers to act as a bridge between patient and doctor. For the patient, it's seamless. They are getting a surgery done by a Glamyo surgeon, at one of the Glamyo partners - a chain of over 250 co-branded hospitals, with over 150 surgeons across 16 cities at present.
The next hurdle is price. Very few can afford quality healthcare out of pocket, so we enable EMI payments.
To get back to the customer experience, you or your attendant does everything right now. You go from department to department, get the doctor's discharge summary, take it to the billing desk, and so on. Our team takes over all of this, from start to finish.
Arunima: A competitive price is attractive, but when it comes to healthcare, there are many unique questions in a customer's mind, and two of the most important are: postoperative care and how to go forward if the surgery is not successful?
Preet: Most larger hospitals are focused on high criticality surgeries, and elective surgery isn't a high priority. We introduce a clearly defined protocol, including two follow-ups with the patient, one immediately after the day of surgery and one a week after. In between, we track the patient's recovery. We ensure that a patient is not left to fend for themselves at any point.
Arunima: I have had a surgery, and there is an issue, whom do I go to? The hospital or Glamyo?
Preet: We assign a medical counsellor to you, and this person will assist in the event you face any issues. The medical directorate team and medical counsellor arrange a follow-up with the same surgeon who has operated on you and at the same hospital.
Archit: We make sure there are clear cut agreements with hospitals and surgeons:
With the hospital, the agreement says that infrastructure requirements are the hospital's responsibility, including the OT, the OT staff, the consumables, etc. If any of these are not up to the mark, the hospital bears the indemnity. Billing is done in the hospital's name to make things transparent.
The agreement with the surgeons clarifies that they bring to the table their medical expertise, and in any instance of negligence or other problems, they bear the liability. Surgeons also sign indemnity bonds before procedures.
So far, our patient experience has been outstanding. Our NPS score is above 75, and our Google ratings are 4.5, while an average hospital rating is 3/3.5
Arunima: A lot of people compare this to the Oyo model. Do you think this is a fair comparison?
Preet: Oyo aggregates hotels and then brands them and standardises their services. That is where the similarity ends. If a guest were to get a less than the optimal bed, they would have a minor irritation, but in our case, if a patient were to get sub-optimal medical care, the consequences could be far graver. Hence, the amount of control, precision of systems and processes, and diligence required are far greater than an Oyo will need to do.
Arunima: I read that Glamyo generally focuses on cosmetic procedures. Is this true? Or did you start with this focus and then change?
Preet: We were leaning more towards cosmetic and gynaecology and orthopaedic surgery at first, but we began working in multiple categories as we started scaling. We added eye care surgeries, oncology, urology, and laparoscopic procedures. I think now we are very well diversified.
Arunima: How much money have you raised so far on the business front?
Preet: We have raised USD6 million, and we are in the process of a very large round of fundraising targeting USD25 to 30 million.
Arunima: How many full-time doctors do you have on the rolls?
Preet: We have 150 doctors on our platform, and one hundred forty of them are consultants, and ten are full-time.
Glamyo Health Co Founders
Arunima: What's the overall strength of the company right now?
Preet: 200+ people.
Arunima: How many surgeries have you conducted so far?
Preet: 5,000. And this number is increasing every month. We are adding more than a thousand surgeries a month.
Arunima: This is in how many cities?
Preet: 16 cities
Arunima: Compared to corporate hospitals, how much cheaper are your rates?
Archit: We are 25-30% cheaper than a large corporate hospital.
Arunima: Can you give an example of a common surgery to see the pricing difference?
Preet: Piles surgery from corporate hospital costs around Rs 50-55,000. You can get it done on our platform at Rs 30-35,000.
Arunima: Has it been difficult finding partner hospitals?
Archit: On the contrary, it's been quite easy for us to onboard hospitals because they are used to an environment where they get outside surgeons or surgeons bringing in their patients. We're organising this existing trend. Instead of the surgeons bringing their surgeries, we are saying that we will bring bulk surgeries to your hospital as a company. We're looking at the best 25-30 hospitals in every city, and identifying these is simple. Many hospitals have low capacity utilisation, often as low as 45-50%, so they are open to getting additional revenues by working with us.
Arunima: How do you find the surgeons you work with?
Archit: Each city has at least 400-500 well-qualified surgeons, so we find the best 20-25 who are open to this model. We explain our platform to them, including the independence and revenues it gives them. We also do social media profiling for them and run ads in their name. So there is a lot of visibility for the surgeons, which they don't get in a corporate set-up.
Arunima: How do you bring patients in? A patient can enter their number and contact details on your website, but how do you otherwise reach out if someone needs surgery?
Preet: Customer behaviour has undergone a shift when it comes to elective surgeries. Most patients want elective surgeries and a global level of healthcare delivered locally, and they don't want to travel more than 5kms for a hernia operation. Digital allows us to target patients hyper-locally, so we serve specific content for a particular area. We match a South Delhi patient with a South Delhi doctor in a South Delhi hospital.
What about the 85% of the population who are not reached by digital? We started liaising with general physicians, formalising the process by which they were earlier referring to 20 different places for their surgical requirements. We are also addressing corporate insurance channels, and these are some of the methods we use to reach patients.
Because we don't operate our physical assets, we generate trust through our actions and branding. One of our strategies was to associate with a celebrity who could convey our ethos of trust, maturity, and dependability. We found Rajat Kapoor a perfect fit, and he has done a splendid job in communicating our values to our audience.
Arunima: What are the most popular surgery verticals that you offer?
Archit: Our top five are proctology, urology, ophthalmology, dental, and cosmetic surgery.
Arunima: There is a concern that startups like Glamyo are aggressively selling surgery to patients.
Preet: The most effective counter to this is to align incentives in the right manner. Our medical counsellor arranges a meeting between a prospective patient and a surgeon. This is the single most crucial KRA. That's it. That's where his role ends in terms of the medical aspect. The surgeon then takes the call as to whether the surgery is required or not required.
I would also like to focus on what a system like ours brings to the healthcare ecosystem. We bring in additional patients, and revenue starts increasing. The hospital can now invest in training and upgrading. So, not only do our 25 patients benefit, but the hospital's existing 30-35 patients also benefit. The second point is, we are increasing the ease of access to high-end technology. Imagine a rickshaw-puller or daily wage earner. He has piles, his go-to is a civil hospital, and he gets a standard piles surgery done which will require him to be away from work for two weeks. Every day is a wage lost. For Rs 30,000, we provide laser treatment, which lets him recover in 3-5 days. We can do this because we leverage existing infrastructure.
Arunima: Do you usually focus on single-speciality hospitals?
Preet: Our preferred hospital would be a 20, 30, or 40-bed hospital with 1 or 2 units in a city, which is not a brand but offers excellent quality. Our hospitals are largely NABH-accredited, and have good ICU set-ups and round-the-clock RMO support.
Arunima: Do you only focus on cities, or do you also focus on small towns?
Archit: There are 44,000 hospitals in India, and the top 10 chains account for around 400 hospitals. Apollo has only 71 hospitals, Fortis and Max have only 25-26 hospitals each. We are already at 300+ hospitals. All the 16 cities I have worked in have the kind of hospital we want to work with. There are such hospitals in the smaller towns, and it is just that the big chains can't tap that segment unless they decide to go asset-light.
Arunima: When you reach out to the hospitals, given that the hospital is responsible for any mishap, is that a concern for them?
Preet: Hospitals are already used to dealing with a patient who has not been generated by the hospital, operated on by a surgeon who is not the full-time surgeon of the hospital. We're aggregating this model. So hospitals are already used to the risk and responsibility of this model, and it's standard for them.
Arunima: What is the usual duration of your contract with a hospital?
Preet: It's usually a one-year contract, although all our partner hospitals have opted to renew so far.
Arunima: How do you identify the surgeons you work with?
Preet: Initially, we identified specific parameters to ensure a base level of quality. We focused on surgeons with 8-10 years of experience who have worked with one or more of the largest chains. We also rely on Google reviews and Practo reviews. Once a doctor is in our system, we start generating our data on the doctor. That helps us to fine-tune the selection of new doctors further. We give them relevant training if doctors don't perform well on patient-related NPS scores. We keep refining our selection procedure and course-correcting our existing partners as needed. It's the same with hospitals.
Arunima: What was the impact of COVID on Glamyo?
Archit: During the COVID months, the demand for surgeries and the availability of hospitals was constrained, particularly in the first and second waves. But it was a very, very short-term impact, and I would say that overall our growth hasn't been impacted much. It helped us get leaner, and we could control our costs and make our model more efficient.
Arunima: Do you also provide other services like sourcing hospital supplies?
Archit: At present, we don't. We are completely focused on surgery as a revenue model right now. However, we are launching an adjacent business on the insurance side, focused on providing insurance support to patients. We have also launched dental as a new category.
Arunima: What would be the long-term value that Glamyo brings to the healthcare system in India?
Archit: The more significant problem is that 95% of Indians cannot get quality healthcare because they cannot afford to pay or don't have the correct information. We want to reach out to at least 5% of that 30 million, and that is our vision for the next 4 to 5 years.
Preet: We're essentially doing what Amazon does, which is to empower the customer to make the best decision. That's the difference we want to make to patients in India.